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Incorporating Psychology
into Dietetics Practice in
the Head & Neck Cancer
Population
Claudia	Gonzalez,	MS	
New	York	University	Diete;c	Intern
Head	and	Neck	Cancer	
	Depression
Depression	&	Weight	Loss	
Depressive	
symptoms			
Weight	Loss		
(Van	Liew		et	al.,2016)
Depression			
	
	
Weight	
loss		
	
	
Malnutri2on				
	
	
Poor	nutrient	
intake
Head	and	Neck	Cancer	
Malnutrition		
Malnutri2on	
	
Treatment	interrup2ons		
Reduced	effec2veness		
Reduced	survival		Increased	morbidity		
(Van	Liew		et	al.,2016)
Addressing	Depression:		
Bringing	psychology	into	the	mix	
	
1.	Can	psychological	strategies	
impact	nutri&on	status?
Heads	Up	
	
70	control	
59	interven;on			
	
Control	
•  RD		
	
Interven2on	
•  RD	
•  Psychologist		
Using	psychological	interven&on	by	psychologists		to	improve	nutri2on	
status	in	HNC	pa2ents			
Nutri;on	
Depression	
Mortality		
Assessing	for:		
(BriUen	et	al.	2017)
PRIMARY	ANALYSIS	
RESULTS	
Nutri;on		 Depression			 Mortality				
No	significant	differences	
between	control	and	
interven;on	group
Addressing	Depression:		
Bringing	psychology	into	the	mix…	
	
2.	Can	psychological	strategies	
be	implemented	into	diete&cs	
prac2ce?
Eating	As	Treatment	(EAT)	
Using	psychological	interven&on	by	trained	RDs	to	improve	nutri2onal	
behaviors	in	HNC	pa2ents			
151	control		
156	interven;on		
	
Control	
•  Care	as	usual		
Interven2on	
•  Eat	to	LIVE		
Assessing	for:		
Nutri;on	Status		
Weight	loss	
Depression		
Treatment	interrup;ons	
Unplanned	admissions	
Length	of	stay		
(BriUen	et	al.	2018)
EAT	Intervention	
Aer	week	5	 5	weeks	later		
Change	talk		
Nutri2on	Plan			
Monitor		
Ini.ally	(rela.onship	building)		
Nutri2on	Assessment	
	
Depression	Screening	
	
Eat	to	LIVE	convo	
	
(BriUen	et	al.	2018)
Promising	Results		
Nutri2onal		
status			
Weight			
Depression		
Treatment	
interrup2ons		
(BriUen	et	al.	2018)
ReGlections	
•  New	research		
	
•  Heads	Up	vs.	EAT	to	LIVE–	Psychological	interven;on	conducted	by	
psychologists	vs.	Registered	Die;;ans.		
	
•  Promising	impact	of	CBT/MI	on	nutri;on	related	outcomes.			
	
•  Future	Implica2ons:		
•  Training	RDs	to	screen	for	depression.		
•  Training	RDs	in	MI/CBT.			
•  Enforcing	collabora;ve	rela;onships	between	RDs	and	pa;ents	in	an	
inpa;ent	care	se_ng.
References	
1.	BriUon,	B.,	Baker,	AL.,	Clover,	K.,	Mcelduff,	P.,	WraUen,	C.,		Carter,	G.	(2017).	Heads	Up:	a	pilot	
trial	of	a	psychological	interven;on	to	improve	nutri;on	in	head	and	neck	cancer	
pa;ents	undergoing	radiotherapy.	European	Journal	of	Cancer	Care,	26:	1-10.		Doi:	10.1111/ecc.
12502	
	
2.	BriUon,	B.,	Baker,	AL.,	Wolfenden,	L.,	WraUen,	C.,	Bauer,	J.,	Beck,	AK.,	McCarter,	K.,	
Harrowfield	,J.,	Isenring,	E.,	Tang,	C.,	Oldmeadow,	C.,	Carter,	G.	(2018).	Ea;ng	As	Treatment	(EAT):	
A	Stepped-Wedge,	Randomized	Controlled	Trial	of	a	Health	Behavior	Change	Interven;on	
Provided	by	Die;;ans	to	Improve	Nutri;on	in	Pa;ents	With	Head	and	Neck	Cancer	Undergoing	
Radia;on	Therapy	(TROG	12.03).	Interna.onal	Journal	of	Radia.on	Oncology,	103(2):	353-362.	
hUps://doi.org/10.1016/j.ijrobp.2018.09.027		
3.	Van	Liew,	JR.,	Brock,	RL.,	Christensen,	AJ.,	Karnell,	LH.,	Pagedar,	NA.,	Funk,	GF.	Weight.	(2016).		
Loss	aer	head	and	neck	cancer:	A	dynamic	rela;onship	with	depressive	symptoms.	Head	&	
Neck	,	370-370.	Doi:	10.1002/hed.24601

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